My first sialolith today.

Actually it was a bit of a disappointment. My patient brought my this jar with the "something" that gushed out of the floor of her mouth. I was hoping to see a little mass of some description. It was just some fluff in water. But worthy of note, none the less. Maybe it decompressed!!!!

Anyway, she is a young adult who suddenly complained of a golf ball -sized swelling underneath her jaw on Friday night. Her ear also ached a little, and it felt as if her "glands" were swollen. It hurt a little during dinner.

BTW, when most people say "their glands are up" are actually referring to their lymph nodes, which are not exactly glands.
Her GP (general medical practitioner) ruled an ear infection and told her to see her dentist (me!).

It felt like there was a firm lump in her right submandibular region, and not exactly consistent with lymphadenopathy. That was Friday. I ruled out her wisdom teeth, even though they were impacted and needed removal, I don't think they were symptomatic. I told her it might be her salivary glands, but I wasn't sure at that stage.

Today, the account of her weekend was pathognomonic of an obstructed salivary gland - obstructed by a stone, a salivary calculus, a sialolith. There was swelling at meal time, more pain at meal times and the floor of her mouth was swollen. But something happened one hour before she saw me - she felt something dislodge into the floor of her mouth, followed by a gush of saliva. That bit of fluff in the jar (she said it was more compact when she first saw it) came out.

The orifice of the duct of the salivary gland was a little red. I took an occlusal radiograph in an attempt to see if there was more stone in the ductal system. No, there wasn't one large enough to show up on my dental x ray. I sent her for a special x ray, a sialogram, to see if there was more stone blocking other parts of the glandular system.

Quick anatomy: the submandibular gland is located underneath the lower jaw, but the duct that pours the saliva into the mouth exits under the tongue behind the lower teeth. And obstruction/blockage anywhere in this system leads to a build up of saliva in the gland, and swelling and pain during meal times. This condition is then known as sialolithiasis.

She's coming back to see me after the sialogram.